Red Cell Distribution Width in Acute Pulmonary Embolism Patients Improves 30-Day Mortality Risk Stratification Based on the Pulmonary Embolism Severity Index - 17/05/22
Abstract |
Purpose |
To validate red cell distribution width (RDW) as an improvement in 30-day mortality risk stratification based on the Pulmonary Embolism Severity Index (PESI) in acute pulmonary embolism (PE).
Patients and Methods |
Prospective observational analysis of consecutive adult acute PE patients.
Results |
Among 731 patients, 30-day mortality was 11.9%. With adjustment for the PESI score and number of covariates, higher RDW was associated with higher mortality (RDW continuous: OR 1.21, 95% CI 1.06–1.38; Bayesian OR 1.22, 1.07–1.40; RDW ‘high’ [>14.5% in men >16.1% in women] vs normal: OR 3.83, 1.98–7.46; Bayesian OR 3.98, 2.04–7.68]. Crude mortality was 3.6% if PESI 86–105 (intermediate risk), but 1.2% if RDW normal and 7.1% if RDW high; 11.8% if PESI 106–125 (high risk), but 3.6% if RDW normal and 18.8% if RDW high. Adjusted probabilities showed higher mortality (ORs between 3.5–5.8) if RDW was high in any PESI risk subgroup. Crude mortality rates in two random-split subsets (n=365 and n=366) again showed the same patterns.
Conclusions |
On-admission RDW above the normal range improves 30-day mortality risk stratification based on PESI score in acute PE. Particularly, it corrects PESI-based intermediate-risk or high-risk allocation by reclassification into very low-risk (<3.5%) or very high-risk (>11.0%).
Le texte complet de cet article est disponible en PDF.Highlights |
• | The Pulmonary Embolism Severity Index (PESI) is a well-validated tool for prediction of 30-day mortality in acute pulmonary embolism (PE) patients that still needs additional improvement in early mortality risk estimation among intermediate-risk and high-risk groups |
• | There is a need for a simple, fast, cheap and widely available marker that could be used as a reliable add-on tool to PESI in an emergency room or any clinical or organisational setting |
• | This study showed that red cell distribution width reliably reclassified a substantial number of PESI intermediate-risk and high-risk patients into low-risk or very high-risk categories, and that its simple dichotomised use could further improve decision-making in acute pulmonary embolism in the emergency room setting with limited resources |
Keywords : Acute pulmonary embolism, 30-day mortality, Pulmonary Embolism Severity Index, Red cell distribution width
Plan
Vol 31 - N° 6
P. 859-866 - juin 2022 Retour au numéro
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